AB0955 Disease activity impact over the anxiety level in patients with psoriatic arthritis
Authors: N. D. Popescu, A. Dima, I. A. Berza, G. M. State, F. Negoi, M. Panduru, M. Parvu
Journal: Annals of the Rheumatic Diseases (2022)

Background Psoriatic arthritis (PA) is a complex, systemic, chronic inflammatory condition with substantial multisystemic detrimental effects on patients’ health status. In PA patients there was reported increased anxiety occurrence when compared to general population, even if specific predictors are not defined yet [1]. Objectives To characterize disease-related predictors of anxiety in patients with PA. Methods Cross-sectional study with prospective, successive inclusion of patients fulfilling the CASPAR (ClASsification criteria for Psoriatic ARthritis) classification criteria for PA. Anxiety level was assessed using the General Anxiety Disorder-7 (GAD-7) with a cut-off of 10 points as previous defined [2]. Moreover, disease activity status for PA was defined using also validated scores, namely the Disease Activity Index for Psoriatic Arthritis (DAPSA), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Ankylosing Spondylitis Disease Activity Score (ASDAS), cutaneous involvement by the Psoriasis Area Severity Index (PASI), and comorbidities by Psoriatic arthritis comorbidity index (PsACI). Results 56 PA patients were included, 29 (51.8%) males, with mean±SD age at inclusion of 54.1±13.2years. Regarding the tools for disease activity assessment, the probability of impact over a high anxiety level as estimated by area under curve (AUC) was high (&gt; 0.800) for BASDAI [AUC(95%CI) 0.859 (0.738-0.979)], especially in relation with the last 3 items about inflammation of other than neck, back or hip joints and morning stiffness (see Figure 1). Figure 1. The Area Under the curve of the Receiver Operating Characteristic (AUROC) for high anxiety level (GAD-7 &gt; 10) In bivariate analysis, we found a significant difference regarding a higher anxiety level as assessed by GAD-7 for female gender (28.6% vs. 78.9%, p=0.001), concomitance of peripheral and axial articular involvement (25.7% vs. 52.6%, p=0.034), DAPSA (14.8 (7.1; 22.8) vs. 24.6 (12.2; 36.8), p=0.035), BASDAI (3.1 (1.3; 4.1) vs. 7.1 (5.0; 8.0), p&lt;0.001), and ASDAS-CRP (2.5 (1.1; 3.7) vs. 3.5 (2.7; 4.0), p=0.038), but not for the other parameters search, namely age, smoking, alcohol intake, home settle (urban/ rural, living alone, kids), disease duration, HLA-B27 status, PASI, PsACI, Patient (PtGA) or Physician (PGA) Global Assessment, ongoing corticosteroid treatment, or inflammation status (ESR, CRP). In multivariate analysis, the PA disease-related predictor for increased anxiety was the auto-evaluation by BASDAI, OR (95%CI) 1.844 (1.198 - 2.839) (see Table 1). Table 1. Independent predictors for anxiety in psoriatic arthritis patients Parameter 95% CI p-value lower upper Gender, F/M (%F) 0.106 0.023 0.498 0.004 Articular axial and peripheric, Y/N (%Y) 0.289 0.055 1.503 0.140 DAPSA 1.017 0.973 1.063 0.460 BASDAI 1.844 1.198 2.839 0.005 ASDAS-CRP 1.312 0.877 1.964 0.186 Conclusion Therefore, higher BASDAI results were associated with increased anxiety in PA and so such results should raise awareness about the need of search for associated anxiety disorders. On the contrary, the extension of the cutaneous involvement, the systemic inflammation level or the comorbidities degree were not identified as predictors for the anxiety occurrence. References [1]Zusman EZ, Howren AM, Park JYE, et al. Epidemiology of depression and anxiety in patients with psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2020; 50 :1481–8. doi:10.1016/j.semarthrit.2020.02.001 [2]Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med 2006; 166 :1092 7.doi:10.1001/archinte.166.10.1092 Disclosure of Interests None declared